ASSOCIATION BETWEEN PAIN AND FALL WORRY AMONG COMMUNITY-DWELLING OLDER PEOPLE WITH DEMENTIA IN THE UNITED STATES

Abstract Previous studies have found that pain is associated with fall worry among community-dwelling older adults. However, both pain and fall worry are poorly understood and under-addressed among community-dwelling older people with dementia (cd-OPWD). We thus sought to examine the association between pain and fall worry among this vulnerable subgroup. We used data from the 2015 National Health and Aging Trends Study (analytic sample: cd-OPWD who were self-interviewed, n=1103; mean age: 79; age range: 65-107). The number of pain sites in the prior month was assessed by presenting the cd-OPWD with a card listing common pain sites (e.g., back, knees). Past-month fall worry was assessed by two questions, “did you worry about falling down” and “did this worry ever limit your activities”. Fall worry was endorsed by 34%; activity-limiting fall worry was endorsed by 39% of those with fall worry. Twenty percent reported a single site of pain, and 53% reported multisite pain. Those who endorsed fall worry were more likely to have a higher number of pain sites, and those who reported activity-limiting fall worry were more likely to report knee, hand, or leg pain. In multinomial logistic regression analyses, adjusting for sociodemographic and health characteristics, a higher number of pain sites was significantly associated with activity-limiting fall worry. These findings suggest pain and fall worry are common among cd-OPWD and can be elicited directly from them. Fall prevention for cd-OPWD should prioritize pain management to mitigate activity-limiting fall worry, since activity limitation increases the risk of falls.

academic medical center.However, few comprehensive studies exist.Therefore, for the current work, we reviewed fifty CTAs that were obtained for ischemic stroke triage and thrombectomy planning at a comprehensive stroke center in Hawaii (Queens Hospital, Honolulu HI).These brain CTAs were analyzed for arterial and venous variants and other abnormalities that might place the patient at increased risk for arterial injury and/or venous congestion, both of which may result in cognitive decline.The CTAs were analyzed retrospectively for every known level of venous and arterial stenosis, and CVC-associated pre-morbid symptoms were analyzed.Preliminary data support the hypothesis that venous anatomical anomalies may be a risk factor for cognitive impairment.CVC may be an under-diagnosed contributor to cognitive impairment, particularly in older patients.

INTERDISCIPLINARY APPROACHES TO EPIDEMIOLOGY AND PREVENTION OF FALLS IN OLDER ADULTS
Chair: Wenjun Li Discussant: Wenjun Li Prevention of falls is important to independent living and good health in older age.This symposium brings together five interdisciplinary studies on falls among community-dwelling older adults.The first presentation examines the relationship between multisite pain and fear of falling among older adults with dementia.The second discusses the differential effects of anxiety on indoor vs. outdoor falls.The cohort study found that anxiety was associated with higher rate of indoor but not outdoor falls.The third investigates racial differences in association of accelerometer measured physical activity with indoor and outdoor falls.The study found that a 30-minutes increase in moderate-to-vigorous intensity physical activity was associated with 25% lower rate of indoor falls and 42% higher rate of outdoor falls among non-White but not White participants, an interesting example of effect modification by race and location of falls.The fourth reports findings of a cross-sectional survey of older adults in Thailand which observed high prevalence of falls, and substantial differences in fear of falling, daily activities and quality of life between fallers and non-fallers, and between persons with and without fear of falling.The fifth reports rural-urban differences in circumstances and correlates of falls from the same study in Thailand.The study found higher fall rates, higher level of fear of falling and worse general health in urban than rural residents, highlighting the need for considering urbanrural differences in falls prevention.Together, these studies demonstrate the complexity and promises of interdisciplinary approaches to falls research.

Seattle, Washington, United States, 3. University Of Washington, School of Medicine, Seattle, Washington, United States
Previous studies have found that pain is associated with fall worry among community-dwelling older adults.However, both pain and fall worry are poorly understood and under-addressed among community-dwelling older people with dementia (cd-OPWD).We thus sought to examine the association between pain and fall worry among this vulnerable subgroup.We used data from the 2015 National Health and Aging Trends Study (analytic sample: cd-OPWD who were self-interviewed, n=1103; mean age: 79; age range: 65-107).The number of pain sites in the prior month was assessed by presenting the cd-OPWD with a card listing common pain sites (e.g., back, knees).Past-month fall worry was assessed by two questions, "did you worry about falling down" and "did this worry ever limit your activities".Fall worry was endorsed by 34%; activity-limiting fall worry was endorsed by 39% of those with fall worry.Twenty percent reported a single site of pain, and 53% reported multisite pain.Those who endorsed fall worry were more likely to have a higher number of pain sites, and those who reported activity-limiting fall worry were more likely to report knee, hand, or leg pain.In multinomial logistic regression analyses, adjusting for sociodemographic and health characteristics, a higher number of pain sites was significantly associated with activity-limiting fall worry.These findings suggest pain and fall worry are common among cd-OPWD and can be elicited directly from them.Fall prevention for cd-OPWD should prioritize pain management to mitigate activity-limiting fall worry, since activity limitation increases the risk of falls.

THE ASSOCIATION OF ANXIETY WITH INDOOR AND OUTDOOR FALLS AMONG COMMUNITY-DWELLING OLDER ADULTS
Lingming Chen 1 , Elizabeth Procter-Gray 1 , Linda Churchill 2 , Meng Zhang 1 , Qun Le 1 , Sarah Berry 3 , Marian Hannan 4 , and Wenjun Li 1 , 1. University of Massachusetts Lowell, Lowell, Massachusetts, United States, 2. University of Massachusetts,Lowell,Lowell,Massachusetts,United States,3. Hebrew Rehabilitation Center,Boston,Massachusetts,United States,4. Harvard Medical School,Boston,Massachusetts,United States One in three older adults aged 65 years or greater fall at least once each year.The effects of psychosocial factors on falls remain to be fully understood.This study examined the association of anxiety with subsequent indoor and outdoor falls among older adults.The prospective cohort study enrolled 359 community-dwelling older adults aged 65-95 years old in central Massachusetts (2018)(2019)(2020).Anxiety at baseline was measured by the Beck Anxiety Inventory.Falls were reported on monthly falls calendars, and when a fall was reported, the circumstances were collected via telephone interview.Negative binomial models were used to estimate the effect of anxiety on indoor and outdoor falls, separately.Models were adjusting for sociodemographic, physical health (BMI, bodily pain, comorbidities), depression, stress, functional status (Activities of Daily Living, chair standing test), physical activity, drinking, smoking, the fear of falling and ever fallen in the past year.Overall, the rates of indoor falls and outdoor falls were 41 per 100 person-years and 46 per 100 person-years, respectively.Anxiety was a statistically significant predictor of indoor falls; for every one point increased in Beck Anxiety Inventory, there was a 6% increase in the incident rate of indoor falls after adjusting for covariables listed above (IRR (95% CI): 1.06 (1.01-1.11)).Anxiety was not significantly associated with outdoor falls (IRR (95% CI): 0.98 (0.93-1.02)).In conclusion, anxiety was associated with higher rate of indoor falls but not outdoor falls.Future falls prevention should consider the differential impact of anxiety on indoor and outdoor falls.

RACIAL DIFFERENCES IN ASSOCIATION OF OBJECTIVELY MEASURED PHYSICAL ACTIVITY WITH INDOOR AND OUTDOOR FALLS
Qun Le 1 , Linda Churchill 2 , Kevin Kane 1 , Lingming Chen 1 , Scott Crouter 3 , Sarah Berry 4 , Marian Hannan 5 , and Wenjun Li 1 , 1. University of Massachusetts Lowell, Lowell, Massachusetts, United States, 2. University of Massachusetts,Lowell,Lowell,Massachusetts,United States,3. The University of Tennessee Knoxville,Knoxville,Tennessee,United States,4. Hebrew Rehabilitation Center,Boston,Massachusetts,United States,5. Harvard Medical School,Boston,Massachusetts,United States Fall-related injury and hospitalization rates have been steadily increasing by 2% and 4% per year.Physical Activity Guidelines advise older adults to remain physically active to promote muscle strength, bone health, and balance.The Healthy Aging and Neighborhood Study enrolled 379 community-dwelling persons aged 65 years or older in Central Massachusetts (2018)(2019)(2020).Participant physical activity (PA) levels were measured using waistworn Actigraphy accelerometers for at least 8 hours per day for 5 or more days including 1 weekend day.Average daily PA intensities were categorized according to minutes of sedentary (SB), light (LPA), and moderate-to-vigorousintensity PA (MVPA) using Copeland cutoffs.Falls, including the circumstances of the fall, were ascertained using monthly falls calendars and follow-up telephone interviews.Negative Binomial Regressions were used to estimate the associations of PA with rates of indoor and outdoor falls.Models were run overall and by race, with all models adjusting for age and gender.Mean age was 73.71(SD:6.41)years, 58.31%(n=221) were female, and 35.62%(n=135) were non-White.There was no significant difference in SB, LPA, and MVPA by race.White race was associated with higher rates of outdoor falls (RR(95% CI)=2.73 (1.51, 4.93)).Every 30 more minutes of MVPA was significantly associated with 25% lower rate of indoor falls (RR(95% CI)=0.74 (0.58, 0.97)) and 42% higher rate of outdoor falls (RR(95% CI)=1.42 (1.04, 1.95)) among non-White but not White (p for interaction=0.03,0.07, respectively).Socioeconomic factors may explain the differences observed by race.Thus, future investigations should consider socioeconomic when examining indoor and outdoor falls.